Elevator pitch

Rounds are taking forever and seem to be getting worse every day, with ICD-10, letters
to patients, and keeping track of everything else you need to do. You've misplaced
all your notes and can't remember all the details of the labs you need to order, the
notes you need to write, or the calls you need to make. It's a disaster.

You walk through the ED and see how having a scribe has made the clinicians there
more efficient. It chaps your hide that you don't have your own amanuensis. You have
tried for weeks to get someone to at least consider the idea.

You run to the elevator and jump on as the doors are closing. (Note: This practice
is not recommended for reasons described in the June 2011 Newman's Notions.) As you press the button for your floor, you notice that the only other passenger
is the chief of medicine. You have wanted to speak with her for weeks, but her secretary
is obstructionist and says it will be 6 weeks till you can get on her schedule.

You have only met the chief twice before, and you are nervous, but you work up the
courage to say, “Hey, we should hire scribes for rounds.” The chief
looks at you and gives an odd little smile before exiting the elevator at the next
stop. Fail.

Illustration by David Rosenman

Too bad you were not ready with your elevator pitch. A good pitch must be concise
and clear, engaging and persuasive, well-rehearsed and actionable (while still seeming
conversational), and, most important, less than 30 seconds long. This concept applies
whether you're trying to get a job, propose a project, or join a committee.

Knowing this, you're prepared when you later find yourself in the elevator with the
vice-chair. “Hi, Dr. C. I'm Dr. Pregunta, a hospitalist. Would you like to
see hospital rounds be more efficient and medical records completed in a timely fashion?
I would like to suggest we hire scribes. Scribes are able to capture documentation
and improve income as well as increase provider satisfaction. They are used in our
own emergency department. The addition of scribes would be cost-efficient, with increased
productivity outweighing the labor cost. I'd like the opportunity to discuss this
with you sometime soon. Thanks.”

You still might not get that scribe, and darn it, you were so distracted you got off
on the wrong floor, but at least now you've taken a shot.

Not only hospitalists but also patients can benefit from having an elevator pitch
at the ready.

For example, Mr. Nebulous is being discharged tomorrow. You spent 4 hours with Mr.
N. this week explaining his disease. He was admitted for aspiration pneumonia status
post-CVA, had septicemia, and now has a PICC and is getting IV antibiotics for 6 weeks
since his blood cultures are negative. It's pretty straightforward stuff, from your
standpoint. But maybe not from his.

His daughter calls him and wonders why he was in the hospital. He thinks for a second,
then says, “They don't know what the heck is wrong with me. They're just using
a bunch of big words to hide that fact. They're kicking me out today.”

Why is Mr. Nebulous laying down such vile calumny on your communicative and diagnostic
prowess? It's because he doesn't understand what really happened, and he doesn't have
an elevator pitch.

When patients get discharged, everyone they know wants to know why they were in the
hospital. And if they don't understand exactly why or are unable to explain, it's
embarrassing, and it's easier to shift the focus to the clinician.

So what would Mr. N.'s elevator speech sound like? “I had a stroke last month,
and the food would not go down the right tube, so I got pneumonia and the infection
even got into my blood. I could have died, but I'm better now and going home on antibiotics
through this fancy IV. I have to see my doctor in 3 weeks.” It is simple and
accurate. And if he gets admitted somewhere else (perhaps with C. diff from the antibiotics you gave him!), he can tell his own story to clinicians as well.

So here's my pitch: Do you want your patients to be able to explain why they were
in the hospital? Teach them their own elevator pitches, so that they can concisely
summarize their hospitalization and ongoing care plan. It will reflect well on your
communication skills, make everyone happy, and perhaps even speed discharge. I hope
I have persuaded you to consider this strategy.

Dr. Newman is a hospitalist at Mayo Clinic in Rochester, Minn., and the editorial
advisor and humor columnist for ACP Hospitalist.

ACP Hospitalist provides news and information for hospitalists, covering the major issues in the field. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated.